COPD Chronic Obstructive Lung Disease

COPD is the occurrence of chronic bronchitis or emphysema, a pair of commonly co-existing diseases of the lungs in which the airways become narrowed

Risk Factors
Smoking, occupational exposure, alpha 1-antitrypsin deficiency (not reported in Korea)

CAUSE
tracheobronchial infection: Hemophilus influenza, Streptococcus pneumoniae, Moraxella catarrhalis, Mycoplasma neumoniae

Symptoms
chronic cough , Sputum, respiratory distress, weight loss

anorexia, mental stress , depression , anxiety

diagnosis
physical findings: barrel-shaped of the chest, paradoxical movement of the lower rib cage , wheezing

pulmonary function tests: FVC, FEV1, FEV1/FVC arterial blood gas analysis chest X-ray

Treatment Oxygen Therapy Bronchodilator Steroid

antibiotic: beta lactam

respirato

diffuse parenchymal lung disease Restrictive lung disease DPLD of known cause, idiopathic interstitial pneumonia,

granulomatous DPLD,
Other etc.

Symptoms
acute chest pain, Hemoptysis , Velcro rale , clubbing

Diagnosis History, Blood tests , anti-neutrophil cytoplasmic autoAb (ANCA), Pulmonary function tests, Chest HRCT

bronchoalveolar lavage, BAL lymphocytes transbronchial lung biopsy

Idiopathic pulmonary fibrosis elders (50-70 years), dry cough , shortness of breath Fine inspiratory crackle ,

clubbing ,
Chest HRCT(honeycomb lung)

Diagnosis Major criteria (1) Exclusion of other known causes of ILD (drugs, environmental exposures, connective tissue diseases)

(2) Abnormal pulmonary function showing evidence of restriction

(3) Bibasilar reticular abnormalities on HRCT (4) transbronchial lung biopsy or broncho alveola lung biopsy showing no features to support an alternative diagnosis

Minor criteria
(1) Age > 50 yrs (2) Unexplained shortness of breath (3) Duration of illness 3 mo (4) Bibasilar inspiratory crackles

(NSIP)nonspecific interstitial pneumonitis Elders (40-70 years), dry cough , shortness of breath ,

Idiopathic pulmonary fibrosis (clinical symptoms is short) ,

broncho alveola lung biopsy (lymphocytes) ,

(COP) cryptogenic organizing pneumonia symptoms cough, sputum, fever,

flu-like ,
shortness of breath

chest X RAY
Bilateral or unilateral areas of consolidation Patchy , nodular opacities, Reticulo-nodular pattern

Solitary pulmonary nodule

A solitary pulmonary nodulus needs to be separated from larger lung tumors, a single lesion in the lung completely surrounded by lung parenchyma with a diameter less than 3 cm and without associated pneumonia, atelectasis

Diagnosis
radiographs nodule and Calcification pattern ( 2 years ago) diffuse, laminated ,popcorn , centersection in calcification ( + nodular)

malignant tumors (corona radiata sign ,Air-bronchus sign)

PerCutaneous Needle Aspiration PCNA,

CT scan , Fluoroscopy , Ultrasound , Positron Emission Tomography (PET)

Treatment
surgery Video-Assisted Thoracoscopic Surgery

lung cancer
60~70 squamous cell carcinoma, adenocarcinoma , small cell lung carcinoma

Cause smoking , occupational exposure (arsenic, chromium, nickel, asbestos, radiation), air pollution,

indoor Pollution,
genetic factors

squamous cell carcinoma proximal lobe (center),

histological : Keratinization

intercellular bridge
The relatively slow growth (doubling time: 130 days)

Adenocarcinoma
peripheral type (3/4) Solitary pulmonary nodule slow growth (doubling time: 500 days), common metastasis

large cell carcinoma

peripheral type , similar to adenocarcinoma

small cell carcinoma

smoking , center type, doubling time: 100 days, metastasis

adenosquamous cell carcinoma

adenocarcinoma and squamous cell carcinoma of the Mixed

Symptoms cough, dyspnea, hemoptysis, chest pain ,

loss of appetite,
weight loss and fever

nerve invasion: laryngeal nerve palsy , diaphragmatic paralysis(Shortness of breath) ,

Eighth cervical nerves and the first and second thoracic nerve invasion vascular occlusion (superior vena cava)
redness and swelling

Arrhythmia , lymph nodes enlarge

metastasis: liver, adrenal glands,brain ( common)

headache, vomiting

endocrine
Cushing syndrome squamous cell carcinoma hypercalcemia

Diagnosis Sputum cytology , bronchoscopy transbronchial needle aspiration,

Chest X-ray imaging ,

CT , PET , MRI , percutaneous biopsy

Pleural effusion
Pleura Visceral , parietal , pleural space normal Pleural effusion fluid

mesothelial cells , monocytes, lymphocytes , Granulocytes , protein, albumin,

glucose ,
LDH

Clinical symptoms pleuritic chest pain ,

Friction rubs,
pleural effusion : decreased breath sounds, percussion (dull)

Diagnosis Ultrasound ,
CT scan,

Treatment Thoracentesis ,
Thoracotomy with pleurectomy

Empyema, empyema thoracis pleural effusion due to pus cause contiguous bacterial infection of the lung , external contamination due to penetrating trauma,

chest tube ,
esophageal perforation

Chylothorax pleural effusion due to leakage of chyle (thoracic duct) cause lymphoma , lung cancer with mediastinal spread , mediastinal fibrosis milky appearing exudate fat globules

Treatment surgery ddx. : Pseudochylothorax similar gross appearance ,cholesterol>250 mg/dl long-standing benign effusion(more than 5 years)

Hemothorax grossly bloody pleural effusion, hematocrit

cause Trauma, Anticoagulant therapy , rupture of intrathorcic vessels or aneurysm, Idiopathic

Treatment surgery (thoracostomy)

pneumothorax
pneumothorax is an abnormal collection of air or gas in the pleural space that separates the lung from the chest wall

primary spontaneous pneumothorax

lung disease or other special lesions (without) 20 to 40 men Cause subpleural bleb (Burst)

clinical symptoms chest pain , shortness of breath, cough physical findings: tachypnea, decreased breath sounds , tactile fremitus

percussion Hyperresonance,
chest expansion, Deviated away from diseased side(trachea)

Diagnosis chest X-ray Treatment A small pneumothorax without underlying lung disease may resolve on its own in one to two weeks. aspiration of the free air (chest tube insertion)

secondary spontaneous pneumothorax pneumothorax with lung disease.

sudden shortness of breath

clinical symptoms
shortness of breath, chest pain, cyanosis , hypotension

treatment Chest tube placement , thoracotomy , aspiration

traumatic pneumothorax cause: over distension or rupture (Alveolar), fractured rib, foreign body,

Treatment Chest tube placement

iatrogenic pneumothorax cause Pleural aspiration, pleural biopsy, fine needle aspiration lung, subclavian vein or internal jugular vein Aspiration,

transbronchial biopsy,
Bronchoscopy puncture or laceration

Treatment Chest tube placement

tension pneumothorax emergency positive pressure ventilation

mediastinum moves the opposite side

hypotension cardiovascular collapse Deviated away from diseased side (trachea) Treatment Chest tube placement

Pulmonary embolism
Pulmonary embolism (PE) is a blockage of the main artery of the lung or one of its branches by a substance that has travelled from elsewhere in the body through the bloodstream PE most commonly results from deep vein thrombosis (a blood clot in the deep veins of the legs or pelvis) that breaks off and migrates to the lung, a process termed venous thromboembolism (VTE).

risk factors vascular damage, retention of blood circulation , increase in blood coagulation,

thrombophilia: anti-thrombin III, protein C, protein S

Clinical symptoms asymptomatic , shortness of breath, pleurodynia, hemoptysis

Syncope ,
fever

Diagnosis ECG: sinus tachycardia, The arterial blood gas analysis, lung perfusion scan , D-dimer measurement,

Pulmonary Angiography ,
spiral CT

Treatment unfractionated heparin ,

Low molecular weight heparin,

Warfarin , thrombolytic agent

Inferior vena cava filter, embolectomy